Psychology News & Resources

Regular exercise can play an important a role in improving the physical and mental wellbeing of individuals with schizophrenia, according to a review published in The Cochrane Library. Following a systematic review of the most up-to-date research on exercise in schizophrenia, researchers concluded that the current guidelines for exercise should be followed by people with schizophrenia just as they should by the general population.

“Current guidelines for exercise appear to be just as acceptable to individuals with schizophrenia in terms of potential physical and mental health benefit,” says lead researcher Guy Faulkner of the Faculty of Physical Education and Health at the University of Toronto, Canada. “So thirty minutes of moderate physical activity on most or all days of the week is a good goal to aim for. Start slowly and build up.”

Schizophrenia is a serious mental illness affecting four in every 1,000 people. It is already known that exercise can improve mental health, but so far there has been only limited evidence of effects in schizophrenia. The new review focused on three recent small studies that compared the effects of 12–16 week exercise programmes, including components such as jogging, walking and strength training, to standard care or yoga.

The researchers found that exercise programmes improved mental state for measures including anxiety and depression, particularly when compared to standard care. Changes in physical health outcomes were seen but they were not significant overall. However, the researchers suggest this may be due to the short timescale of the trials.

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Two previous reviews have found exercise therapy to be beneficial in schizophrenia, but called for more rigorous research. “This new review suggests that such calls are starting to be addressed,” says Faulkner. “But we still need more research that will help us learn how we can get individuals with schizophrenia engaged in exercise programmes in the first place, and how such programmes can be developed and implemented within mental health services. That’s one of the biggest challenges for this type of intervention.”

Researchers from the University of Essex found that as little as five minutes of a “green activity” such as walking, gardening, cycling or farming can boost mood and self esteem.

“We believe that there would be a large potential benefit to individuals, society and to the costs of the health service if all groups of people were to self-medicate more with green exercise,” Barton said in a statement about the study, which was published in the journal Environmental Science & Technology.

Many studies have shown that outdoor exercise can reduce the risk of mental illness and improve a sense of well-being, but Jules Pretty and Jo Barton, who led this study, said that until now no one knew how much time needed to be spent on green exercise for the benefits to show.

Barton and Pretty looked at data from 1,252 people of different ages, genders and mental health status taken from 10 existing studies in Britain.

They analyzed activities such as walking, gardening, cycling, fishing, boating, horse-riding and farming.

They found that the greatest health changes occurred in the young and the mentally ill, although people of all ages and social groups benefited. The largest positive effect on self-esteem came from a five-minute dose of “green exercise.”

All natural environments were beneficial, including parks in towns or cities, they said, but green areas with water appeared to have a more positive effect.

You’ve probably heard it before: the brain is a muscle that can be strengthened. It’s an assumption that has spawned a multimillion-dollar computer game industry of electronic brain-teasers and memory games. But in the largest study of such brain games to date, a team of British researchers has found that healthy adults who undertake computer-based “brain-training” do not improve their mental fitness in any significant way.

The study, published online Tuesday by the journal Nature, tracked 11,430 participants through a six-week online study. The participants were divided into three groups: the first group undertook basic reasoning, planning and problem-solving activities (such as choosing the “odd one out” of a group of four objects); the second completed more complex exercises of memory, attention, math and visual-spatial processing, which were designed to mimic popular “brain-training” computer games and programs; and the control group was asked to use the Internet to research answers to trivia questions.

All participants were given a battery of unrelated “benchmark” cognitive-assessment tests before and after the six-week program. These tests, designed to measure overall mental fitness, were adapted from reasoning and memory tests that are commonly used to gauge brain function in patients with brain injury or dementia. All three study groups showed marginal — and identical — improvement on these benchmark exams.

But the improvement had nothing to do with the interim brain-training, says study co-author Jessica Grahn of the Cognition and Brain Sciences Unit in Cambridge. Grahn says the results confirm what she and other neuroscientists have long suspected: people who practice a certain mental task — for instance, remembering a series of numbers in sequence, a popular brain-teaser used by many video games — improve dramatically on that task, but the improvement does not carry over to cognitive function in general. (Indeed, all the study participants improved in the tasks they were given; even the control group got better at looking up answers to obscure questions.) The “practice makes perfect” phenomenon probably explains why the study participants improved on the benchmark exams, says Grahn — they had all had taken it once before. “People who practiced a certain test improved at that test, but improvement does not translate beyond anything other than that specific test,” she says.

The authors believe the study, which was run in conjuction with a BBC television program called “Bang Goes the Theory,” undermines the sometimes outlandish claims of many brain-boosting websites and digital games. According to a past TIME.com article by Anita Hamilton, HAPPYneuron, an example not cited by Grahn, is a $100 Web-based brain-training site that invites visitors to “give the gift of brain fitness” and claims its users saw “16%+ improvement” through exercises such as learning to associate a bird’s song with its species and shooting basketballs through virtual hoops. Hamilton also notes Nintendo’s best-selling Brain Age game, which promises to “give your brain the workout it needs” through exercises like solving math problems and playing rock, paper, scissors on the handheld DS. “The widely held belief that commercially available computerized brain-training programs improve general cognitive function in the wider population lacks empirical support,” the paper concludes.

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Not all neuroscientists agree with that conclusion, however. In 2005, Torkel Klingberg, a professor of cognitive neuroscience at the Karolinska Institute in Sweden, used brain imaging to show that brain-training can alter the number of dopamine receptors in the brain — dopamine is a neurotransmitter involved in learning and other important cognitive functions. Other studies have suggested that brain-training can help improve cognitive function in elderly patients and those in the early stages of Alzheimer’s disease, but the literature is contradictory.

Klingberg has developed a brain-training program called Cogmed Working Memory Training, and owns shares in the company that distributes it. He tells TIME that the Nature study “draws a large conclusion from a single negative finding” and that it is “incorrect to generalize from one specific training study to cognitive training in general.” He also criticizes the design of the study and points to two factors that may have skewed the results.

On average the study volunteers completed 24 training sessions, each about 10 minutes long — for a total of three hours spent on different tasks over six weeks. “The amount of training was low,” says Klingberg. “Ours and others’ research suggests that 8 to 12 hours of training on one specific test is needed to get a [general improvement in cognition].”

Second, he notes that the participants were asked to complete their training by logging onto the BBC Lab UK website from home. “There was no quality control. Asking subjects to sit at home and do tests online, perhaps with the TV on or other distractions around, is likely to result in bad quality of the training and unreliable outcome measures. Noisy data often gives negative findings,” Klingberg says.

Brain-training research has received generous funding in recent years — and not just from computer game companies — as a result of the proven effect of neuroplasticity, the brain’s ability to remodel its nerve connections after experience. The stakes are high. If humans could control that process and bolster cognition, it could have a transformative effect on society, says Nick Bostrom of Oxford University‘s Future of Humanity Institute. “Even a small enhancement in human cognition could have a profound effect,” he says. “There are approximately 10 million scientists in the world. If you could improve their cognition by 1%, the gain would hardly be noticeable in a single individual. But it could be equivalent to instantly creating 100,000 new scientists.”

For now, there is no nifty computer game that will turn you into Einstein, Grahn says. But there are other proven ways to improve cognition, albeit only by small margins. Consistently getting a good night’s sleep, exercising vigorously, eating right and maintaining healthy social activity have all been shown to help maximize a brain’s potential over the long term.

What’s more, says Grahn, neuroscientists and psychologists have yet to even agree on what constitutes high mental aptitude. Some experts argue that physical skill, which stems from neural pathways, should be considered a form of intelligence — so, masterful ballet dancers and basketball players would be considered geniuses.

Jason Allaire, co-director of the Games through Gaming lab at North Carolina State University says the Nature study makes sense; rather than finding a silver bullet for brain enhancement, he says, “it’s really time for researchers to think about a broad or holistic approach that exercises or trains the mind in general in order to start to improve cognition more broadly.”

Or, as Grahn puts it, when it comes to mental fitness, “there are no shortcuts.”

Having an Honors degree in Human Movement Studies and working in gyms in a former life while studying for my Clinical Masters degree, I have seen this to be true. Of course it seems self evident, but these researchers have used great science with an excellent and now research-proven written program and workbook. These, along with their recent meta-analytic research review, show just how effective exercise can be in improving mood.

Credit: PhysOrg.com) — Exercise is a magic drug for many people with depression and anxiety disorders, according to researchers who analyzed numerous studies, and it should be more widely prescribed by mental health care providers.

“Exercise has been shown to have tremendous benefits for mental health,” says Jasper Smits, director of the Anxiety Research and Treatment Program at Southern Methodist University in Dallas. “The more therapists who are trained in exercise therapy, the better off patients will be.”

“Exercise can fill the gap for people who can’t receive traditional therapies because of cost or lack of access, or who don’t want to because of the perceived social stigma associated with these treatments,” he says. “Exercise also can supplement traditional treatments, helping patients become more focused and engaged.”

The Program used in the study is available from bookstores-Click Image to view description

Smits and Michael Otto, psychology professor at Boston University, presented their findings to researchers and mental health care providers March 6 at the Anxiety Disorder Association of America’s annual conference in Baltimore.

Their workshop was based on their therapist guide “Exercise for Mood and Anxiety Disorders,” with accompanying patient workbook (Oxford University Press, September 2009).

The guide draws on dozens of population-based studies, clinical studies and meta-analytic reviews that demonstrate the efficacy of exercise programs, including the authors’ meta-analysis of exercise interventions for mental health and study on reducing anxiety sensitivity with exercise.

“Individuals who exercise report fewer symptoms of anxiety and depression, and lower levels of stress and anger,” Smits says. “Exercise appears to affect, like an antidepressant, particular neurotransmitter systems in the brain, and it helps patients with depression re-establish positive behaviors. For patients with anxiety disorders, exercise reduces their fears of fear and related bodily sensations such as a racing heart and rapid breathing.”

After patients have passed a health assessment, Smits says, they should work up to the public health dose, which is 150 minutes a week of moderate-intensity activity or 75 minutes a week of vigorous-intensity activity.

At a time when 40 percent of Americans are sedentary, he says, mental health care providers can serve as their patients’ exercise guides and motivators.

The patient workbook which accompanies the program - Click image to view description

“Rather than emphasize the long-term health benefits of an exercise program — which can be difficult to sustain — we urge providers to focus with their patients on the immediate benefits,” he says. “After just 25 minutes, your mood improves, you are less stressed, you have more energy — and you’ll be motivated to exercise again tomorrow. A bad mood is no longer a barrier to exercise; it is the very reason to exercise.”

Smits says health care providers who prescribe exercise also must give their patients the tools they need to succeed, such as the daily schedules, problem-solving strategies and goal-setting featured in his guide for therapists.

“Therapists can help their patients take specific, achievable steps,” he says. “This isn’t about working out five times a week for the next year. It’s about exercising for 20 or 30 minutes and feeling better today.”

It is very likely that you have heard your medical practitioner, psychologist or counsellor talk about the benefits of exercise to help get on top of your depression or anxiety.

Here is a repost of an article which discusses some recent examples of these principles in practice, as well as summaries of some recent studies. (Read while jumping up and down on the spot for no less than 15 minutes!)

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When Gaetano Vaccaro meets with depressed patients at Moonview Sanctuary, he sometimes moves part of the session outside, taking a walk while talking. The result: “People’s state of mind can shift.”

Depression can spawn a spiral of lethargy and hopelessness, so that the last thing someone wants to do is exercise. But regular, moderate physical activity may lessen depression symptoms as much as some medications.

“On its own, exercise does appear to have significant effects in terms of elevating mood,” says Dr. Andrew Leuchter, professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior. Physical activity, he adds, is often used to augment treatments such as medication and cognitive behavioral therapy. “If people are on medication or in treatment and haven’t had a complete recovery from depression, exercise is useful in getting them all the way there.” Exercise affects the brain in several ways. “People with depression tend to become somewhat inert, and they don’t engage in their usual activities, and exercise gets people back to their usual level of activity,” Leuchter says. That can prompt an upward cycle, inspiring people to return to work and connect again with friends and family, ultimately providing motivation to stay on course. Such connections are crucial for depressed people.

“The psychological benefits make a big difference from my perspective,” says James Blumenthal, professor of medical psychology at Duke University in Durham, N.C. “People have a greater sense of being in control. They feel better about themselves and have more self-confidence.”

A physical change can instigate a mental change, says Vaccaro, director of development at Moonview Sanctuary, a psychological treatment center in Santa Monica. “When you’re getting somebody to move and getting them to change a pattern in their life, just that little bit of pattern change can relate to a mood change, and they start to see themselves as a person who is active, not just a couch potato. They change their perception.” There may be direct physical effects on the brain as well. The treatment center encourages exercise — yoga in particular — as a way to manage many types of mood disorders. Besides having a strong mind-body connection, “yoga is something that can be modified to someone’s activity level and is something they can do throughout their life,” Vaccaro says.

Mood elevation

Several studies illustrate the benefits of exercise.In one, published in the journal Psychosomatic Medicine in 2007, 202 men and women with major depression were randomly assigned to participate in a supervised exercise program in a group setting, do home-based exercise, take an antidepressant medication or take a placebo pill. After 16 weeks, 41% were in remission, meaning they no longer had major depressive disorder. Those who were in the exercise and medication groups tended to have higher remission rates than the placebo group.

Another study examined how much cardiovascular exercise was needed to see changes in mood among those with mild to moderate major depressive disorder. The 80 men and women who took part in the research were randomly placed in four exercise groups that varied in the number of calories burned and the frequency of the activity. A placebo group did flexibility exercises three days a week. Those in the group that exercised at moderate intensity three to five days a week for about 40 minutes (consistent with public health recommendations) showed the biggest decrease in depressive symptoms compared with those who exercised less, or just did stretching.

The 2005 study appeared in the American Journal of Preventive Medicine. Other pieces of the puzzle are still missing, however. Scientists aren’t sure what changes happen in the brain — and why — when people exercise. Many scientists and physicians believe that exercise increases levels of serotonin, a neurotransmitter thought to be linked to mood regulation. However, most of the studies supporting this have been done on animals. “It’s hard to quantify it in humans for a number of reasons,” Leuchter says. “We don’t entirely understand exactly why patients get depressed in the first place. We have theories, but it’s hard to know in individual cases. And we don’t have a good way of looking at [changes] in the brain.” Scientists do know that exercise causes an increase in blood flow to the brain and raises the amount of energy the brain uses. And even though the link between blood flow and mood isn’t known, Leuchter says, “the brain in general seems to be in a healthier state.”

Activity is key

Exercise may be key in fighting depression, but no generic prescription fits everyone. Overall health and exercise history factor into what kind of regimen might be prescribed. “If someone was a runner, I’d get them back to running,” Leuchter says. “If not, I’m not going to have the goal of turning someone into a major athlete. I’d simply want to get them active, and even walking around the block might be good.” Those who aren’t currently in treatment for depression should consult with a physician before exercising to make sure they have no underlying health problems. Patients who are on medication or in therapy for depression shouldn’t consider exercise a substitute for either treatment. “The key,” Blumenthal says, “is really maintenance. You have to do it on an ongoing basis. You should find something you enjoy, but doing something is better than nothing.”

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About Peter

Peter Brown BHMS (Hons) MPsychClin MAPS

I’m a Clinical Psychologist and have a private practice and consultancy in Brisbane Australia. I have 24 years experience in child, adult and family clinical psychology. I have a wonderful wife and three kids.

I like researching issues of the brain & mind, reading and seeking out new books and resources for myself and my clients. I thought that others might be interested in some of what I have found also, hence this blog…